Open Access

Austin Journal of Tropical Medicine & Hygiene

Review Article
Health Policy and Health Care Reform and its Status in Ethiopia
Bamlak Kassahun1,2*; Aklilu Feleke1 Abstract
1
Microbiology Research Unit, Aklilu Lemma Institute of
Our world is experiencing economic, social, political, epistemo-
Pathobiology, Addis Ababa University, Ethiopia
logical and technological transitions within the past few centuries,
2
Ethiopia Society of Tropical and Infectious Diseases, strongly increasing demand for accessible and affordable health
Ethiopia care. These shifts put significant pressure on the existing outdated,
highly centralized bureaucratic system and the need for injecting
*Corresponding author: Kassahun B new policies and designing new strategies for health care reform
Ethiopian Society of Tropical and Infectious Diseases and become significantly important. Adjusting and managing grow-
Aklilu Lemma Institute of Pathobiology, Swaziland Street, ing demands, the global world has pursued a new round of health
1176, Ethiopia. reforms and governments of different world on biases of their re-
Tel: +251973375396 search finding they starts looking for new policies and strategies
Email: [email protected] that allows them to make a significant reform. The main goals of re-
form health sector reforms are essential drug policies, health care
Received: August 28, 2023 financing and public hospitals. Under this review the main finding
Accepted: September 28, 2023 states that the development of new reform in the health sector
Published: October 05, 2023 needs a serious plan as the medium with the intentions to imple-
ment reforms. A decision to implement a reform was normally ac-
companied by an implementation budget and also its sustainability.
Some of the reforms are implemented speedily and firmly, whereas
others suffered delays and reversals. Reforms implemented in Ethi-
opia shows a significant time dalliance with the speed and firmness
in addressing the gaps in the health sector. Generally it is important
to build an agreement for a better understanding of the unintended
consequences of reform policies and the impact on the health care
reforms.
Keywords: Ethiopia; Health; Policies; Reform
Introduction
Health care reform is one of the fundamental and integral naissance in their health care reform [3]. The Netherlands have
issue for the most part governmental policy deliveries and it is almost a close system with UK and Germany they involve with a
a part of strategical integration. This reform basically target to lower financial threshold opting out to the user. The Swiss sys-
expand the target population who receive health care coverage tems also do have a private health insurance system that ulti-
either in private or public health care centers [1]. The health mately supports the health care system to reform it in easiest
care reform primarily target on addressing very important way. In countries like The United States of America the govern-
agendas like the following. The very important point for health ment provides healthcare support for 25% its citizen that can
care reform is increasing the magnitude of health care provid- help due to the result of health care reform and the policy and
er both in public and private sector, expanding the number of strategy they design. All the above examples shows the exact
professionals in health care specialties, upgrading the quality of scenarios in which the health care reform which is conducted
health care system and decreasing the health care costs for the and managed by different nation results a lots of successes and
consumer [2]. benefit for the users Healthcare is generally centered around
regulated private insurance methods [4].
The current global scenarios indicates that most of the de-
veloped world is involving with the health care reform because Health care reform is a result of health care polices. The
of the advancement of new emerging technologies and emer- Global thread of the health care system shows a strong reform
gence of infectious diseases and non-infectious diseases and and alliance because of the policy and strategies designed. As a
evidence data shows that countries like United Kingdom and global view the key objective the global health system is reduc-
Germany every half decade the design a new strategic reform tion of fraud and abuses that happen in the health care system.
for their health care system this practically lead the nations to To intervene this problem and synchronize the solution to the
advance their work by bringing the power of their health care gap policy maker always target the best way in which they can
organizations into sharp point which allow them to build a re- overcome the problem. In countries like USA and EU estimated
Austin Journal of Tropical Medicine & Hygiene Citation: Kassahun B, Feleke A. Health Care Reform Policy and Status in Case of Ethiopia.
Volume 4, Issue 1 (2023) Austin J Trop Med & Hyg. 2023; 4(1): 1012.
www.austinpublishinggroup.com
Kassahun B © All rights are reserved
Kassahun B Austin Publishing Group

• To revise the process of health care reform and com-

ponents
• To discuss in detail about the development, implemen-
tation and analysis of the health care reform and health care
reform status in Ethiopia
Health Policy
Health policy can roughly see as sum of decisions, plans,
and actions that are undertaken to achieve specific healthcare
goals within a society and predict the strategies which are go-
ing to born. According to the World Health Organization a well-
defined health policy can result and achieve many things: it de-
fines a vision for the future, outlines priorities and the expected
roles of different groups and it builds consensus and informs
people [5].
According to World Health Organization Health policy is de-
Figure 1: The policy process. fined as “the decisions, plans, and actions that are undertaken
amount 10% of their health care system expenditure involve to achieve specific healthcare goals within a society.” There are
with fraud [4]. a lots of groups of health policy, such as public health, mental
health and health care insurance. Due to the extensive nature
To design a sustainable health care response it is necessary of health policy it address directly or indirectly everyone in a
to focus on health care response components. Fundamental given community [6].
change in the health care reform is resulted when a nation ob-
serve and copy a system that is designed or manipulated by Some notable examples of health policy in the United States
other nation and observing transformational health care reform include:
(Bett, 1994). Such kind of walk among a nation are basically
¾¾ Americans policy for disabilities Act (ADA)
work when the benefit and that the outcome of the reform is
successful. The experience of all countries in the health sector ¾¾ The Roe v. Wade Supreme Court decision for right of
reform clearly shows that the success of health care reforms de- protected abortion
pends on how the process is applied, and by whom it is imple-
mented, instead how the contents are formulated [6]. ¾¾ Polices designed for regulatory bodies like the Centers
for Medicaid and Medicare (CMS)
Reforms in the health sector can be said fully sustained be-
cause of the policy that are basically designed and come to How Does Health Policy Happen?
work. The process by which the policy measure the main core The policy process basically passes under intensive review
function of the reform are thoroughly guided by the govern- and discussion forms the research and researcher to higher ex-
ment executive body. Core system of the reform like the gover- ecutive government official. Countries have a well-defined pol-
nance, financial status and resource generation do have a key icy in their health sector to ensure and technically support ac-
role in sustainability and process of the health system reform. cess for all of its citizens, to give a grant for health research, and
Health sector reform is fundamentally connected with like eq- to plan for adequate numbers, distribution and quality of health
uity, efficiency, quality, financing, and sustainability in the provi- workers to meet healthcare goals. Many countries around the
sion of health care [7]. world have established universal health care, which takes the
The development, implementation and process of the health burden of healthcare expenses off of private businesses or indi-
care reform of most countries are guarded with National Health viduals through pooling of financial risk [9]. There are different
Policies, Strategies and Plans which is prepared for sustainable types of ideas for and against universal healthcare and related
health track. WHO has a long track record and experience in health policies and strategies. Healthcare is an important part
supporting different nations in this process and endeavors by of health systems and thus it often includes for one of the larg-
providing a technical support, facilitating material support, sup- est areas of spending for both governments and individuals all
porting the national dialogue and inter-country exchange [8]. over the world. For understanding how heath policy happen let
us has a close look to the policy process in the American politi-
Generally the health care reform can seen as a sum of differ- cal system as example generally entails these steps:
ent policies that can be potentially help the system to upgrade
from the existing system in a way that can potentially combat 1. A bill is introduced in Congress (legislative branch). Evi-
fraud in health care system, managing inflation in the health dence is presented to promote or oppose the bill. It is debated
care system, addressing a qualitative and quantitative health and voted upon.
care centers and increasing the number of professionals. To 2. If the bill is passed into law, regulatory agencies (ex-
achieve this all and sustain the reform it is important to focus ecutive branch) begin drafting rules and regulations to enforce
on the reform process, the policy and implementation or strate- the law.
gies.
3. If a law or regulation is challenged on legal grounds,
Thus the objective of this review paper is:- the Supreme Court (judicial branch) intervenes to interpret the
• To indicate the role of polices in health care reform law or overrule it.
This process is also influenced by partner bodies, like non-

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 02
 Austin Publishing Group

profits. These categories produces research that is then used to are chained together as policy makers fumble around for solu-
promote particular health policy initiatives. Individual members tions in the context of great uncertainty and many internal and
of these groups may be called to testify before Congress on spe- external constraints [14].
cific health policy matters [9].
In different time’s different ideas, novel knowledge and mod-
How Does Research Contribute to the Health Policy? el was developed to explain how policy is made among that one
pluralist assumption is the one who believes that assume that
Health policy often refers to the health-related researches. agenda setting is open and competitive, with the government
Understanding research finding figures are a good input for the acting as an honest broker. Once adopted, though, policies must
health policies, including global health policy, public health pol- still be steered through the implementation process. Because of
icy, mental health policy, health care services policy, insurance the competitiveness of the policy process, outcomes are unpre-
policy, personal healthcare policy and pharmaceutical policy. dictable [15].
Health based researches may cover topics related to healthcare
delivery [10]. Health Policy Development, Implementation and Analysis
Researches also include the governance and implementation Health Policy Development
of health-related policy, sometimes referred to existing health
policy and reform it needs. Conceptual models which are based The health policy development under passes through in
in the help of research can help show the flow from health-re- identifying need, gathering information, drafting, consulting
lated policy development to health-related policy and program and review [16].
implementation and to health systems and health outcomes There are important stages in the development of health
[11]. policy. The following steps summaries the key stages involved
Policy should be understood as more than a national law or in developing policies:
health policy that supports a program or intervention because 1. Identify need
of the research finding it resulted. The policy process encom-
passes decisions made at a national or decentralized level (in- Policies can be developed in requirement of need and in re-
cluding funding decisions) that affect whether and how services sponse to need. The organization needs to constantly assess its
are delivered. Thus, researches are a supportive policy environ- activities, responsibilities and the outside environment in order
ment that facilitate the scale-up of health interventions [12]. to identify the need for policies and procedures.

The Challenges of Implementing Health Policy 2. Identify who will take lead responsibility

Once the policy is developed by the executive body of the A delegate responsible for the responsibility of leading the
government of a new health policy demands more than provid- tasks will select which can be an individual, working group,
ing tasks around a policy document or designing a set of stan- sub-committee or staff members, according to the expertise
dard operating procedures. Effective and equitable health pol- required.
icy implementation requires “the aggregation of the separate 3. Gather information
actions of many individuals, and One of the fundamental imple-
mentation challenge is that the responsibility for health policy Information are going to gathered from different research
implementers usually rests with a different set of governmental output that can potentially serve as a policy development
bodies than the ones who designed the policy. Policy design-
ers most of the time don’t understand the perspective of the 4. Draft policy
implementers. The process of policy implementation requires On biases the gathered information a draft policy will be pro-
working with the actual group in which the policy touches [13]. posed that ensure that the wording and length or complexity
Health Policy Processes of the policy is appropriate to those who will be expected to
implement it.
Policy Process provides a systematic way to develop policies
that can help the government to address public health prob- 5. Consult with appropriate stakeholders
lems in the community. The policy process is like a journey that Policies are most of the time are effective if those affected
takes through five domains, including stakeholder engagement are consulted are supportive and have the chance to be con-
and evaluation. It ultimately results in implementing a policy. sidered and discuss the on the bold implications of the policy.
The policy process is basically breakdown in to smaller steps Depending on whether developing policies to govern the inter-
as sequential parts. These are problem emergence the followed nal working of the nation or external policy positions, you may
by agenda setting then consideration of policy options then wish to consult, for example: Supporters, Staff and volunteers,
travels to decision-making then implementation, and finally researchers.
evaluation (Jordan and Adelle, 2012). 6. Finalize / approve policy
According to the diagram the view of policy process as a part Once the policy passes through the above steps then the fi-
of the 6 important smaller steps leads to tackle first get a partic- nal task is going to be to approve the policy by the mandated
ular problem on the agenda for discussion and, if possible, con- body.
sideration by policy makers. Policy makers then select the best
course of action based on their advisor comment and make the Health Policy Implementation
policy, then it travels administrators for implementation. This Once the policy is done and approved by the mandated gov-
stage-based view focuses that policy is a process involving many ernmental body alone the approved policy doesn’t ensure that
variable parts of government. But in real action, policy agendas a policy will be successful. Implementation should be there to

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 03
 Austin Publishing Group

the policy in a way that can increase the likelihood the policy 2. Promoting and strengthening of inter-sectoral activi-
will achieve its intended outcomes [17]. ties.
The implantation can be done by Educate the people or or- 3. Promotion of attitudes and practices conducive to the
ganizations affected by the new policy, Change pre-existing ad- strengthening of national self-reliance in health development
ministrative operations and systems (or create new ones) and by mobilizing and maximally utilizing internal and external re-
Monitor and/or enforce the policy as needed sources.
Implementation of policies are different across contexts, 4. Assurance of accessibility of health care for all seg-
potentially limiting its impact on population health targeted ments of the population.
and expected outcome. The amount of impact of a policy to
increase health equity depends both on the policy and its im- 5. Working closely with neighboring countries, region-
plementation, requiring ongoing evaluation and stakeholder al and international organizations to share information and
engagement [18]. strengthen collaboration in all activities contributory to health
development including the control of factors detrimental to
Health Policy Analysis health.
Analysis is the process of screening potential policy oppor- 6. Development of appropriate capacity building based
tunities that can address the problem and comparing those op- on assessed needs.
tions to choose the most effective, efficient, and feasible one.
Making a policy analysis ensures that a systematic process to 7. Provision of health care for the population on a scheme
choose the policy option that may be best for situation [2]. of payment according to ability with special assistance mecha-
nisms for those who cannot afford to pay.
1. Research and identify possible policy options.
8. Promotion of the participation of the private sector
This can be done by reviewing research literature, conduct- and nongovernmental organizations in health care [21].
ing an environmental scan, and surveying best practices to un-
derstand what other communities are doing. Health Sector Reform

2. Describe the possible policy options. Health sector reform can be defined as a process with a per-
spective to make a fundamental change within the national and
Policy analysis, pay attention to the health impact, cost of well as the international health care system by mapping polices
implementation, and feasibility of each option. To describe in a way that can bring a successes in the health care system.
these three factors, you can ask yourself and your stakeholders This process involves with by making a shift or arrangement in
questions such as: the institutional settings. The experience of making health sec-
tor reform is not a new concept in our world many nation ex-
3. Rank the possible policy options and pick the one you perience this issue with a critical advancement of the solution
think is best. and The experience of many countries clearly shows that the
Compare the policy options for health impact, economic and success of reforms depends on how the process is applied, and
budgetary impact, and feasibility. Next, rank each one based on by whom, rather than how the contents are formulated [9].
those criteria. Stakeholders can provide guidance on how to do Sustainable health care reform is needed to generate a
this [19]. strong political and public system. This requires a strong and
Health Policy Status in Ethiopia well evidenced information and education on the health sector
reform. Continuous monitoring and review of health systems
The 16th century was a time that Ethiopia was introduced to development is also required to address a fundamental issues
modern medicine. In that time Ethiopian Emperor directly fo- which are against to the health care system. Research also a
cused on direct delivery of immediate primary health care to ci- best tool to provide valid scientific evidence for strengthening
vilians who are injured by accidents. In 1886, doctors who come the processes and mechanisms of health sector reform [10].
from Sweden served as medical staff in Ethiopia in western part
of Ethiopia. At that time there was no any country’s health pol- The health sector reform and renewal emphasis on public
icy simply the Sweden doctor deliver a primary health care to health and all other public health concern issues. Governments
the public as charity work [20]. give a strong attention to health related issues that potentially
recognize the responsibility to enhance the solution that can se-
The first well prepared health policy of Ethiopia outlined in riously affect their health care systems. At the same time, they
1993. The 1993 Ethiopian national policy at that time narrated recognize that in their mixed health systems national health
as different level of priority standards that based on need for policies, strategies and plans have to address the problems of
strategies linked to the democratization and decentralization the entire health sector [12].
of the health system and inter-sectoral collaboration. Develop-
ment of the preventive and promotive components of health Health sector reform requires organizations, individuals and
care. public and private partners to act differently in order to result
a key impact. Yet designing ways to merge the components of
Generally the 1993 Ethiopian National Health Policy focused the health sector reform is a difficult point because one of the
on the following priority agendas. challenge behind to make a global public health sector reform
1. Development of an equitable and acceptable standard is there is no way in combining all those components to central-
of health service system that will reach all segments of the pop- ized system because of this change is almost always resisted or
ulation within the limits of recourses. stagnate [22].

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 04
 Austin Publishing Group

National health policies in different nations and strategies are fulfilled the next phase is addressing the sustainability of
and plans have to address the broad public health agenda. the reform.
Many countries, however, struggle to develop the policy in-
struments to implement advanced health care reform but they Why We Need Health Sector Reform
faced a gap to come over it because of social, political and eco- From a summary of health sector reform in a certain nation
nomic domains [23]. or elsewhere in the world it is visualized as the consistence of
Health Sector Reform and Components applying a significate reform in the health sector is important
to overcome the challenge and to fulfill the gap in the health
The components of health sector reform can be seen as tech- system. There is no consistently applied, universal package of
nically as equity, efficiency, quality, financing, and sustainability. measures that constitutes health sector reform. The process of
This important component do have a significant role in provid- reform is also growing rapidly in many countries especially in
ing opportunities in modernizing the information and the gap the developed world [27].
in a way that the policy makers easily understood. This compo-
nent are trace ways to identify the problems in the health sys- While when we see the health sector reform, new forms
tems that seriously need attention and need to be solved [24]. of relationships among the components can be developed to
make complex changes and interactions. During the last few
The first component of the health sector reform is equity. years, most of these efforts were being spurred principally by
According to CDC equity can be defined as a state in which ev- a targeted agenda to improve equity and quality of care, to ex-
eryone has a fair and just opportunity to attain their highest pand coverage, to decentralize health care management, and
level of health treatment. Achieving this requires strong ongo- also to contain costs in a way that fulfill all the components. The
ing commitments that potentially tackle the problem in a way reforms sometimes do have highly political and fiercely impact
that truly expand fair accessibility to hospitals. Whenever when in the process. In some countries, the reforms became more
there exists a problem in the health sector the primary compo- interconnected due to the presence of a wide range of contract-
nent which is going to be crosschecked is equity [25]. ing partners, including external agencies [28].
Efficiency is also the other second important component of The health care reform usually blocks the question of fea-
Health sector reform. The status of performing activity in the sibility of implementing the change from one direction of the
health sector without or little wastage is known as efficiency. component. What is needed is to strongly understand the is-
Anything that has a significant role in health care system that sues in reform processes to complement what has been learned
clear the way to wastage will be in consideration of the health about the content of reforms. Such an understanding might lead
care system. In different hospital settings and health care cen- to the development of strategies for publicizing or marketing re-
ters because of many determinate factors the efficiency of ad- forms or identification of ways that governments can anticipate
dressing proper health care is not equal. Efficiency in the health and plan for the reactions of organized interest groups [19].
sector reform involves with 3 important types this are alloca-
tive efficiency, productive efficiency and dynamic efficiency. A Challenge and Opportunities of Health Sector Reform
health system can earn a high level of efficiency through the According to the World Health Organization (WHO) report
combination of improving its Allocative Efficiency (AE) and most of the time different nations faces many challenges in the
Technical Efficiency (TE). Allocative efficiency earned when the process of health care reform system because of the potential
health care systems inputs are organized to average outcomes. lack of fulfilling the components. Many of the same challeng-
Impact assessment and evaluation of healthcare interventions es faced by the countries is because of the lack of making the
puts Allocative efficiency at the center of their interest [11]. health system strong agenda that clearly and concretely build-
The third important component of health sector reform is ing better functional links between programmes with mandates
quality. Health care quality is a standard of value which is given that define in terms of specific health outcomes apart from ful-
by any health care provider as determined by some measure- filling components [13].
ments. As with quality definition in other fields, when we de- Most of the challenges in the health sector reform involves
fine quality as part of health sector reform it is an evaluation with the raise of financial problem. Among the health sector
of whether activities in the health care system is good enough reform components finance took the bulk of the portion in ad-
and whether it is suitable for purpose of tackling medical prob- dressing all other components and those with health systems as
lems. According to WHO quality in health care system defined their core business ensuring that the organization as well as the
as providing evidence-based healthcare services to those who nation has the capacity to respond to current issues and identify
need them which indicates that quality of health care delivery future challenges [29].
do have a significant role [26].
Ensuring institutional resources and assets at each level of
Economic issues are found everywhere and wherever we the organization (staff, resources, and convening power) in ev-
go. For the success of implementation of a certain project in ery country are used most effectively to design bridges to the
the health sector economic issues do have a strong role. Un- opportunities. The primary objective of dealing with the chal-
der the health sector reform even though all the problems and lenges and opportunities of the health sector reform framework
challenges are known if there is no financial support for the im- is for action is to clarify and strengthen nations to advanced
plantation there is no success at all in the reform. That is why health system in putting down all mega problems [18].
finance took a fundamental role as a part of health care reform
component. Financing a core function of health care systems The role health systems reform in a changing world is sig-
that can potentially enable progress towards universal health nificate. So the continuity in dealing with the problem is very
coverage by improving effective reforms [14]. important to trace the opportunities. Clear definition and com-
munication is essential in the health sector of all nations. One of
The last one is sustainability once the above all components the biggest challenges that is observed by different health care

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 05
 Austin Publishing Group

system is lack of communication. This problem significantly af- rari, Addis Ababa, and Dire Dawa) have already begun imple-
fects the sustainability of health care reform which is designed. mentation. The strategy recognized that health care should
it is argued that health systems need to be strengthened, it is be financed through multiple financing mechanisms to ensure
essential to be clear about the problems, where and why com- long-range sustainability. The reforms introduced include im-
munication is needed, what will happen as a result if the com- plementing revenue retention and use at health facility level,
munications did not designed well. The approach of this Frame- systematizing a fee-waiver system for the poor, standardizing
work is to define a discrete number of “building blocks” that exemption services, setting and revising user fees, introduc-
make up the system (Leng et al., 2019). ing a private wing in public hospitals, outsourcing nonclinical
services, and promoting health facility autonomy through the
The health care systems have to deal with many challenges. introduction of a governance system [21].
As the spectrum of ill to health drifts, so health systems have
to respond. The capacity to do so is influenced by a variety of Conculution and Recommendation
factors regarding with the development and the sustainability
of the health care reform. Activities which are conducted at na- In summary, Health is a fundamental and critical issue which
tional of sub national level do have a strong impact in decen- should have to be address for all. For the successful health care
tralization of the reform. National health systems are subject system it is very important to focus on policies who involve
to forces that affect performance, such as migration and trade starting from researcher to higher governmental excusive bod-
factors, operating at an international level. Some health policy ies. Policies are potentially powerful to design a specific strategy
challenges are primarily of concern to low-income countries. for public problem and to make a significant reform on the gaps
However, despite national differences, many policy issues are which are faced on the entire health care system. To execute
shared across remarkably different health systems [31]. a significant reform it is very important to focus on research
work, public comments and evaluation of previous reforms in
Agendas like the impact of aging populations, the provision past and the goal they achieved. Developing, Implementing and
of chronic care or social security reform are no longer the con- analysis of reform is a very difficult task which require a strong
cern of developed world. Similarly, the threat posed by new epi- communication and collaborations and if it is supported with
demics, such as avian or human pandemic influenza, requires a strong policy the power of filling the specific gaps on the health
response from all countries rich and poor. So the role of working sector is significant.
on health sector reform regarding with the emergence of infec-
tious diseases need a concerted effort. The differences lie in the Based on the above conclusion the following recommenda-
relative severity of challenges being faced, the way a particular tions are forwarded:-
health system has evolved, and the economic, social and politi- • Before designing any reform regarding with health sys-
cal context – all of which determine the nature and effective- tem it is very important to study the policy in detail and the
ness of the response [17]. target points which are going to be addressed.
The most important part of the health care sector reform • When a reform is planned it is important to fulfill the
which can be seen as a best opportunity is create a clear way components of health sector reforms.
for the global health sector to collaborate and come together.
In middle and low income countries from both local budget and • Health policies and health sector reform should have
external support by designing different economic system sup- to give an attention for prioritized situations in the country.
ports the world with significant solution to tackle health prob- It is very important to seek partners, funder and collabora-
lems [7]. tors when a reform is designed.
Health Care Reform in Case of Ethiopia References
Ethiopia started experiencing a health care reform on financ- 1. Daniels N, Bryant J, Castano RA, Dantes OG, Khan KS, Pannarun-
ing strategy in 1998. For the implementation of the reform wide othai S. Benchmarks of fairness for health care reform: a policy
range of initiative where introduced that can potentially sup- tool for developing countries. Bull World Health Organ. 2000;
port the process of the evolution [32]. 78: 740-50.

The very critical points of the implementation of these re- 2. Li L, Fu H. China’s health care system reform: progress and pros-
form and including the entire process was legalized through re- pects. Int J Health Plann Manage. 2017; 32: 240-53.
gional legislations and operationalized directly with prototype 3. Liu GG, Vortherms SA, Hong X. China’s health reform update.
of implementation frameworks that were modified and aligned Annu Rev Public Health. 2017; 38: 431-48.
within specific regional contexts. The actual implementation
was initiated in 2004, in different nations of Ethiopia like that of 4. West DM, Heith D, Goodwin C. C. Harry and Louise go to Wash-
Amhara, Oromia, and Southern Nations, Nationalities, and Peo- ington: political advertising and health care reform. J Health
ple (SNNP) Regional States following ratification and endorse- Polit Policy Law. 1996; 21: 35-68.
ment of regional proclamations, regulations, and directives by 5. Bett BJ. Health care reform. J Am Board Fam Pract. 1994; 7: 537.
the respective regional councils (Parliaments), regional execu-
tive Councils (Cabinets), and Regional Health Bureaus (RHBs) 6. Krafka TL. Health care reform. S D J Med. 1993; 46: 217.
[20]. 7. Somberg J. Health care reform. Am J Ther. 2009; 16: 281-2.
Currently, there are expanded reform work activity except 8. Mwabu G. Health care reform in Kenya: a review of the process.
Afar and Somali, which are still in the process of endorsing legal Health Policy. 1995; 32: 245-55.
and operational frameworks. Implementation is already started
9. Flint SS, Gorin SH. Health care reform in the 2008 presidential
in all other regions (Tigray, Benshangul Gumuz, Gambella, Ha-
primaries. Health Soc Work. 2008; 33: 83-6.

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 06
 Austin Publishing Group

10. Khatri P. Health care reform, 2014: no matter what the question, 22. Maynard A, Bloor K. Health care reform: informing difficult
mission is the answer. Fam Syst Health. 2014; 32: 253-5. choices. Int J Health Plann Manage. 1995; 10: 247-64.

11. Fuchs VR, Emanuel EJ. Health care reform: why? What? When? 23. Southby RF. Health care reform: looking back to go ahead. Med
Health Aff (Millwood). 2005; 24: 1399-414. J Aust. 2008; 189: 33-4.

12. Loftman BA. Health care reform: individual freedom or collectiv- 24. Darling H. Health care reform: perspectives from large employ-
ism? J Med Assoc GA. 1995; 84: 231-3. ers. Health Aff (Millwood). 2010; 29: 1220-4.

13. Degeling P, Carr A. Leadership for the systemization of health 25. Javitt MC. Health care reform: ready for prime time. AJR Am J
care: the unaddressed issue in health care reform. J Health Or- Roentgenol. 2009; 193: 283.
gan Manag. 2004; 18: 399-414.
26. Sachs FL. Health-care reform--will it play in Peoria? Conn Med.
14. Lorant V, Grard A, Nicaise P, Title 107 Study Group. Implement- 1994; 58: 237-8.
ing a nation-wide mental health care reform: an analysis of
stakeholders’ priorities. Community Ment Health J. 2016; 52: 27. Freeman CW, Boynton XL. Implementing health care reform
343-52. policies in China. Challenges and opportunities USA. Center for
Strategic and International Studies. 2011.
15. Sparer MS. U.S. health care system reform. J Health Polit Policy
Law. 2010; 35: 309-11. 28. Walt G. Implementing health care reform: a framework for. Crit
Chall Health Care Reform Eur. 1998; 365.
16. Giaimo S. Who pays for health care reform?. 2001.
29. Denis JL, Forest PG. Real reform begins within: an organizational
17. Gorin SH. The Patient Protection and Affordable Care Act, cost approach to health care reform. J Health Polit Policy Law. 2012;
control, and the battle for health care reform. Health Soc Work. 37: 633-45.
2010; 35: 163-6.
30. Leng Y, Liu W, Xiao N, Li Y, Deng J. The impact of policy on the in-
18. Contandriopoulos D, Brousselle A. Reliable in their failure: an tangible service efficiency of the primary health care institution-
analysis of healthcare reform policies in public systems. Health based on China’s health care reform policy in 2009. Int J Equity
Policy. 2010; 95: 144-52. Health. 2019; 18: 14.

19. Holds JB. Is health care reform a gathering storm, for doctors? 31. Wenzel RP, Rohrer JE. The iron triangle of health care reform.
Mo Med. 2016; 113: 104-5. Clin Perform Qual Health Care. 1994; 2: 7-9.

20. Barnabas GA, Zwi A. Health policy development in wartime: 32. Kloos H. Primary health care in Ethiopia under three political
establishing the Baito health system in Tigray, Ethiopia. Health systems: community participation in a war-torn society. Soc Sci
Policy Plan. 1997; 12: 38-49. Med. 1998; 46: 505-22.

21. Hartwig K, Pashman J, Cherlin E, Dale M, Callaway M, Czaplinski

C, et al. Hospital management in the context of health sector
reform: a planning model in Ethiopia. Int J Health Plann Manage.
2008; 23: 203-18.

Submit your Manuscript | www.austinpublishinggroup.com Austin J Trop Med & Hyg 4(1): id1012 (2023) - Page - 07